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. 2023 Jan 27;18(1):e0280937.
doi: 10.1371/journal.pone.0280937. eCollection 2023.

Optimising fundoscopy practices across the medical spectrum: A focus group study

Hamish P Dunn  1   2   3   4 , Christine J Kang  2 , Samuel Marks  2   5 , Stewart M Dunn  2   6 , Paul R Healey  2   3   5 , Andrew J White  2   3   5   7
Affiliations

Optimising fundoscopy practices across the medical spectrum: A focus group study

Hamish P Dunn et al. PLoS One. .

Abstract

Introduction: Fundoscopy can be of great clinical value, yet remains underutilised. Educational attempts to improve fundoscopy utilisation have had limited success. We aimed to explore the barriers and facilitators underlying the uptake of clinical direct ophthalmoscopy across a spectrum of medical specialties and training levels.

Methods: Ten focus groups were conducted with medical students (n = 42), emergency department doctors (n = 24), basic physician trainees (n = 7), hospital physicians (n = 6) and general practitioners (n = 7). Independent thematic analysis of transcripts was conducted by three investigators. A consensus thematic framework was developed, and transcripts were reanalysed using this framework.

Results: Thematic analysis identified seven main themes: (1) technical barriers to performing fundoscopy examinations; (2) clinical culture and expectations regarding fundoscopy; (3) the influence of fundoscopy on clinical management; (4) motivation to perform the examination; (5) novel technology including smartphone fundoscopy, and the value of a digital fundus image; (6) training requirements, and; (7) use of limited resources.

Conclusion: Our results build a more nuanced picture of the factors which determine fundoscopy utilisation. As current barriers limit practice by clinicians and medical students, expertise and confidence performing and interpreting fundoscopy are lost. This shifts the balance of perceived clinical utility to futility in changing patient management, and reinforces a cycle of reducing fundoscopy utilisation. We identified important cultural barriers such as accepted incompetence, and misperceptions of senior discouragement. Emerging technologies reduce the technical barriers to fundoscopy. Therefore education should: focus on detecting pathology from digital images; clarify the role of fundoscopy in patient management, and; be targeted at key career progression points.

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Conflict of interest statement

I have read the journal’s policy and the authors of this manuscript have the following competing interests: The Westmead Hospital Dept of Ophthalmology has received research funding for other clinical trials from Hill-Rom/Welch Allyn. The authors received no personal funds and the funder had no involvement in study design or research publication. This does not alter our adherence to PLOS ONE policies on sharing data and materials.

Figures

Fig 1
Fig 1. Themes arising from the focus groups regarding the barriers and facilitators of performing fundoscopy.
See this image and copyright information in PMC

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